Health Care

Galilee Diary #472, January 6, 2010 Marc Rosenstein

And if you do obey these rules and observe them carefully, the Lord your God will maintain faithfully for you the covenant He made on oath with your fathers...The Lord will ward off from you all sickness; He will not bring upon you any of the dreadful diseases of Egypt, about which you know, but will inflict them upon all your enemies. -Deuteronomy 7:12, 15

A recent trip to the regional specialty clinic in Haifa reminded me that for all the criticisms that it is possible to level at Israel for the gap between rich and poor, and for the inequalities in opportunities for different ethnic groups, one area in which we really have the right to be proud of our achievements is the health care system. First of all, it is important to point out that Israel has universal basic health care coverage. In return for a small monthly payroll deduction (waived for those who don't have a paycheck), every citizen can choose to enroll in one of several national HMOs. All normal, routine care and preventive care are covered, and there is a large "basket" of more expensive treatments, diagnostic tests, hospitalization, and medications that are included. Of course, the system is not infinite, and there is always controversy about what conditions or treatments are excluded from the "basket." Moreover, the limitations and inefficiencies that are probably inherent in any such system lead to class-based inequalities: those who can afford it buy supplemental insurance to cover what the system doesn't - and bypass the bureaucracy and waiting periods by paying for surgery privately. And at any given time there is a least one campaign being waged in the media to raise money for someone needing a hugely expensive treatment (e.g., organ transplant). The system clearly has its deficiencies. But it is a system that works. Everyone, regardless of religion or social class or ethnic group, can go to the doctor, can get a prescription for an expensive antibiotic, can have a CT scan, can see a top specialist - without stopping to wonder how to pay for it. Is the equality absolute? No, if you live in the periphery you'll have to spend time and money travelling to that regional specialty clinic; if you live in an unrecognized Bedouin village your local clinic may be limited in equipment (and in the hours it has electricity). If you are a foreign worker, you may be at the mercy of your labor contractor. We still have plenty to do; but it seems that the glass is way more than half full.

But wait, there's more. Like anywhere in the world, rich and poor people live separately here. And Jews and Arabs attend separate schools, live in separate neighborhoods, speak different mother tongues. Hospitals and clinics, on the other hand, are a rather amazing model of integration, from the senior doctors to the cleaning crew - and of course including the patients. To visit a hospital is to encounter every stratum and sector of Israeli society working side by side, healing side by side, suffering side by side (i.e., bedside by bedside). All is not, of course, sweetness and light. I know that there are Jewish employees of Nahariyah hospital who resent the fact that an Arab doctor was appointed hospital director; I'm sure there are caregivers who complain about having to clean up after Ethiopians/Moroccans/Russians/Arabs/whatever. Israel is, after all, populated mostly by human beings. On the whole, however, I don't think it is an exaggeration to say that the health care system is essentially blind to race, religion, and national origins. While there are Israeli policies in the West Bank that have an "apartheid" feel about them, anyone who thinks this is an "apartheid state" should be taken to visit a hospital in the Galilee or the triangle or Jerusalem. Like every place in the world, we have our quota of racists and classists and sexists here. But unlike some places in the world, we seem to have internalized the belief that health care is simply a right due to every member of society equally, and I have never heard a voice arguing otherwise.